11A - Laserfiche WebLink

STATE OF CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES Cal OES ID No: Cal OES 130 DESIGNATION OF APPLICANT'S AGENT RESOLUTION FOR NON-STATE AGENCIES BE IT RESOLVED BY THE OF THE (Governing Body) (Name of Applicant) THAT ,OR (Title of Authorized Agent) OR (Title of Authorized Agent) (Title of Authorized Agent) is hereby authorized to execute for and on behalf of the ,a public entity (Name of Applicant) established under the laws of the State of California,this application and to file it with the California Governor's Office of Emergency Services for the purpose of obtaining certain federal financial assistance under Public Law 93-288 as amended by the Robert T.Stafford Disaster Relief and Emergency Assistance Act of 1988,and/or state financial assistance under the California Disaster Assistance Act. THAT the ,a public entity established under the laws of the State of California, (Name of Applicant) hereby authorizes its agent(s)to provide to the Governor's Office of Emergency Services for all matters pertaining to such state disaster assistance the assurances and agreements required. Please check the appropriate box below: ❑This is a universal resolution and is effective for all open and future disasters up to three(3)years following the date of approval below. This is a disaster specific resolution and is effective for only disaster number(s) Passed and approved this day of ,20 (Name and Title of Governing Body Representative) (Name and Title of Governing Body Representative) (Name and Title of Governing Body Representative) CERTIFICATION I, ,duly appointed and of (Name) (Title) ,do hereby certify that the above is a true and correct copy of a (Name of Applicant) Resolution passed and approved by the of the (Governing Body) (Name of Applicant) on the day of ,20 . (Signature) (Title) Cal OES 130(Rev.9/13) Page 1